|
Destruction 2-14 lesions 17003
|
$21.00 |
$21.00 |
$21.00 |
$78.61
|
|
Destruction anal lesion(s)
|
$475.20 |
$475.20 |
$475.20 |
$3,711.00
|
|
Destruction anal lesion(s)
|
$1,010.40 |
$1,010.40 |
$1,010.40 |
$3,363.79
|
|
Destruction anal lesion(s) smpl chem 46900
|
$450.60 |
$450.60 |
$450.60 |
$557.90
|
|
Destruction benign lesions < 14 lesions
|
$210.60 |
$210.60 |
$210.60 |
$240.24
|
|
Destruction by injection tx of nerve 64630
|
$444.60 |
$444.60 |
$444.60 |
$1,646.40
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$1,363.80 |
$1,363.80 |
$1,363.80 |
$1,652.35
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$3,442.80 |
$3,442.80 |
$3,442.80 |
$3,296.80
|
|
Destruction cryosurgery anal lesion(s) simpl 46916
|
$442.20 |
$442.20 |
$442.20 |
$375.87
|
|
Destruction laser surgery anal lesions 46917
|
$872.40 |
$872.40 |
$872.40 |
$3,640.00
|
|
Destruction mal lsn s/n/h/f/g 2.1-3cm
|
$411.00 |
$411.00 |
$411.00 |
$513.60
|
|
Destruction mal lsn s/n/h/f/g 3.1-4cm
|
$376.20 |
$376.20 |
$376.20 |
$558.97
|
|
Destruction mal lsn t/a/l 3.1-4cm
|
$395.40 |
$395.40 |
$395.40 |
$482.00
|
|
Destruction mal lsn t/a/l >4cm
|
$475.20 |
$475.20 |
$475.20 |
$569.80
|
|
Destruction penis lesion(s) chem 54050
|
$251.40 |
$251.40 |
$251.40 |
$332.00
|
|
Destruction penis lesion(s) exten 54065
|
$424.20 |
$424.20 |
$424.20 |
$2,507.31
|
|
Destruction premal lesions 15/> 17004
|
$327.60 |
$327.60 |
$327.60 |
$442.61
|
|
Destruction rectal tumor 45190
|
$1,093.80 |
$1,093.80 |
$1,093.80 |
$3,245.23
|
|
Destruction vag lesions complex 57065
|
$456.00 |
$456.00 |
$456.00 |
$3,986.00
|
|
Destruction vag lesions simple 57061
|
$220.80 |
$220.80 |
$220.80 |
$4,006.38
|
|
Destruct penis les/smp/electrodesi 54055
|
$397.80 |
$397.80 |
$397.80 |
$2,837.09
|
|
Developmental screen/score/document 96110
|
$25.20 |
$25.20 |
$25.20 |
$142.38
|
|
Devel tst phys/qhp 1st hr
|
$18.60 |
$18.60 |
$18.60 |
$350.40
|
|
Device ablt adv novasure
|
$2,287.80 |
$2,287.80 |
$2,287.80 |
$6,237.48
|
|
Device intraute mirena
|
$2,161.20 |
$2,161.20 |
$2,161.20 |
$2,125.00
|
|
Device tiss remov myosure reach
|
$2,122.80 |
$2,122.80 |
$2,122.80 |
$2,515.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$229.20 |
$229.20 |
$229.20 |
$227.25
|
|
Dexamethasone 4 mg tablet
|
$2.23 |
$2.23 |
$2.23 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$47.02 |
$47.02 |
$47.02 |
$20.76
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$853.51 |
$853.51 |
$853.51 |
$884.80
|
|
Dextran 40 infusion
|
$28.53 |
$28.53 |
$28.53 |
$151.20
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$34.90 |
$34.90 |
$34.90 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$37.55 |
$37.55 |
$37.55 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$133.20 |
$133.20 |
$133.20 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$50.40 |
$50.40 |
$50.40 |
$79.30
|
|
Diabetes training group per 30 min g0109
|
$16.80 |
$16.80 |
$16.80 |
$35.43
|
|
Diab manage trn ind/group
|
$37.80 |
$37.80 |
$37.80 |
$54.99
|
|
Diag laparo separate proc 49320
|
$619.80 |
$619.80 |
$619.80 |
$7,104.72
|
|
Diagnostic anoscopy spx 46600
|
$165.00 |
$165.00 |
$165.00 |
$195.50
|
|
Diagnostic digital breast tomosynthesis bil
|
$31.20 |
$31.20 |
$31.20 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$31.20 |
$31.20 |
$31.20 |
$75.93
|
|
Diagnostic laryngoscopy 31505
|
$162.60 |
$162.60 |
$162.60 |
$242.14
|
|
Diagnostic laryngoscopy 31575
|
$301.20 |
$301.20 |
$301.20 |
$338.00
|
|
Diagnostic Mammogram (both breasts)
|
$295.80 |
$295.80 |
$295.80 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$231.60 |
$231.60 |
$231.60 |
$314.00
|
|
Dialysis circuit perm vascular embolization 36909
|
$347.40 |
$347.40 |
$347.40 |
$5,741.00
|
|
Diatrizoate meglumine 18 % urethral solution
|
$86.95 |
$86.95 |
$86.95 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$939.09 |
$939.09 |
$939.09 |
$79.71
|
|
Dicyclomine injection
|
$161.30 |
$161.30 |
$161.30 |
$154.33
|
|
Diffusing capacity
|
$154.80 |
$154.80 |
$154.80 |
$336.80
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$23.45 |
$23.45 |
$23.45 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$8,839.56 |
$8,839.56 |
$8,839.56 |
$10,279.62
|
|
Digoxin total therapeutic drug level
|
$81.60 |
$81.60 |
$81.60 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$245.07 |
$245.07 |
$245.07 |
$297.86
|
|
Dilate esophagus 1/mult pass
|
$303.60 |
$303.60 |
$303.60 |
$1,548.00
|
|
Dilation/female urethra/initial 53660
|
$138.60 |
$138.60 |
$138.60 |
$235.61
|
|
Dilation of anal sphincter
|
$352.80 |
$352.80 |
$352.80 |
$2,166.04
|
|
Dilation of cervical canal 57800
|
$115.80 |
$115.80 |
$115.80 |
$4,446.00
|
|
Dilation of rectal stricture 45910
|
$1,032.00 |
$1,032.00 |
$1,032.00 |
$2,491.80
|
|
Dilation salivary duct 42650
|
$164.40 |
$164.40 |
$164.40 |
$2,675.71
|
|
Dilation/urethral strict/male/ini 53620
|
$231.00 |
$231.00 |
$231.00 |
$1,372.80
|
|
Dilator fascial 10fx20cm
|
$160.20 |
$160.20 |
$160.20 |
$402.10
|
|
Dimecaprol injection
|
$158.35 |
$158.35 |
$158.35 |
$314.63
|
|
Dimenhydrinate injection
|
$22.36 |
$22.36 |
$22.36 |
$30.48
|
|
Dimethyl sulfoxide 50% 50 ml
|
$98.40 |
$98.40 |
$98.40 |
$1,258.20
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$0.35 |
$0.35 |
$0.35 |
$1.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$17.75 |
$17.75 |
$17.75 |
$18.32
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$20.32 |
$20.32 |
$20.32 |
$98.15
|
|
Direct advanced life support
|
$241.20 |
$241.20 |
$241.20 |
$236.00
|
|
Disability dlco
|
$191.40 |
$191.40 |
$191.40 |
$293.76
|
|
Disaccharidases
|
$174.00 |
$174.00 |
$174.00 |
$230.40
|
|
Discectomy ant dcmprn cord thoracic 1 ntrspc 63077
|
$2,813.40 |
$2,813.40 |
$2,813.40 |
$3,636.00
|
|
Discectomy ant dcmprn cord thoracic ea ntrsp 63078
|
$370.20 |
$370.20 |
$370.20 |
$370.20
|
|
Dis site tele svcs rhc/fqhc
|
$94.80 |
$94.80 |
$94.80 |
$96.75
|
|
Dist revas ligation hemo
|
$2,282.40 |
$2,282.40 |
$2,282.40 |
$6,396.89
|
|
Diverticulectomy/hypophar/esoph 43130
|
$1,542.60 |
$1,542.60 |
$1,542.60 |
$6,547.81
|
|
Division of fallopian tube 58605
|
$641.40 |
$641.40 |
$641.40 |
$976.50
|
|
#d/lmeth-l-methamphetamine
|
$213.60 |
$213.60 |
$213.60 |
$72.14
|
|
Dna antibody native/double stranded
|
$102.60 |
$102.60 |
$102.60 |
$100.00
|
|
Dna gardnerella
|
$74.40 |
$74.40 |
$74.40 |
$61.83
|
|
Dna probe chlamydia
|
$57.00 |
$57.00 |
$57.00 |
$82.20
|
|
Dna probe gc
|
$56.40 |
$56.40 |
$56.40 |
$79.38
|
|
Dna trichomonas
|
$74.40 |
$74.40 |
$74.40 |
$63.00
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$50.08 |
$50.08 |
$50.08 |
$95.06
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$528.48 |
$528.48 |
$528.48 |
$949.39
|
|
Dolasetron mesylate
|
$116.27 |
$116.27 |
$116.27 |
$44.65
|
|
Dolasetron mesylate oral
|
$114.21 |
$114.21 |
$114.21 |
$156.80
|
|
Domicil/r-home visit est pat
|
$117.00 |
$117.00 |
$117.00 |
$117.00
|
|
Domicil/r-home visit est pat
|
$183.60 |
$183.60 |
$183.60 |
$183.60
|
|
Domicil/r-home visit est pat
|
$259.80 |
$259.80 |
$259.80 |
$259.80
|
|
Domicil/r-home visit est pat
|
$372.60 |
$372.60 |
$372.60 |
$372.60
|
|
Domicil/r-home visit new pat
|
$110.40 |
$110.40 |
$110.40 |
$110.40
|
|
Domicil/r-home visit new pat
|
$159.00 |
$159.00 |
$159.00 |
$159.00
|
|
Domicil/r-home visit new pat
|
$271.80 |
$271.80 |
$271.80 |
$271.80
|
|
Domicil/r-home visit new pat
|
$360.60 |
$360.60 |
$360.60 |
$360.60
|
|
Domicil/r-home visit new pat
|
$418.80 |
$418.80 |
$418.80 |
$418.80
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$19.51 |
$19.51 |
$19.51 |
$65.40
|
|
Doppler echo complete
|
$938.40 |
$938.40 |
$938.40 |
$558.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$414.60 |
$414.60 |
$414.60 |
$679.64
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$198.60 |
$198.60 |
$198.60 |
$481.65
|
